UPMC | University of Pittsburgh Medical Center For Reference Only MEDICINE 2013 Summary of Services and Availability (by location) Each location has sufficient space, equipment, staffing and financial resources in place or available in sufficient time as required to support each requested privilege. On an ongoing basis, the organization consistently determines the resources necessary for each requested privilege related to the facility's scope of service. Please review the following Summary of Services and Availability by Location prior to making your selections. If a facility is specifically identified below as NOT having a privilege/service available, you will NOT be considered for that privilege at that individual facility. Any request made that is identified as not available at an individual site will be considered Not Applicable for that site(s), and will be identified as such on your final approved Delineation of Privileges form. Key “x” means Privilege is Available at that location. “C” means contractual arrangement restricts granting this privilege. “N/A” means Privilege Not Available at that location. Facility Codes: MERCYSSSC= UPMC Mercy South Side Surgery Center Privilege MERCYSSSC Core Privileges X Consultation Privileges X ALLERGY / IMMUNOLOGY Allergy Disease Management X Telemedicine CARDIOLOGY Cardiac Disease Management X *Cardiac Catheterization Diagnostic N/A *Cardiac Catheterization Angioplasty N/A *Cardiac Catheterization Right Heart N/A Myocardial Biopsy N/A Echo Interpretation N/A Echo Transesophageal X *Electrophysiological Studies N/A *Electrophysiology Ablation N/A Tilt table testing N/A Holter Monitor Interpretation N/A 30 Day Event Monitor Interpretation N/A ICD Implant including Biventricular & CS Lead N/A Implant *Pacemaker Insertion – Permanent (includes N/A Biventricular & CS Lead Implant) *Pacemaker Insertion - Temporary N/A UPMC | University of Pittsburgh Medical Center For Reference Only MEDICINE 2013 Page 2 of 5 Privilege MERCYSSSC Pericardiocentesis N/A Nuclear Stress Testing X Stress Echocardiography N/A Stress EKG N/A CVP line placement N/A Intra-aortic Balloon Insertion N/A Swan-Ganz Insertion N/A Intracoronary stent-Transcatheter Placement N/A Carotid Doppler studies N/A Peripheral Doppler studies N/A Muga Interpretation X Aortic Valvuloplasty X *PFO Closures X *ASD Closures X Femoral Artery Closure Devices X Intracardiac Echo X *Atrial Tansseptal Puncture X Cardiac/Coronary CT Scans X Interpret Nuclear Studies X Perform and interpret Cardiac MRI N/A Placement of Transvenous Pacemaker X Defibrillation/Cardioversion X Transthoracic Echocardiography (limited) X Moderate sedation N/A Excimer Laser N/A Fluoroscopy (Certificate Required) N/A Telecardiology N/A CRITICAL CARE Medical supervision of intensive care unit patients, N/A emergency transport, critical illness, and multi- system organ failure Arterial catheter insertion N/A Central venous and percutaneous dialysis catheter N/A insertion Pulmonary artery catheter insertion N/A Pericardiocentesis N/A Placement of transvenous pacemaker N/A Intra-aortic balloon insertion N/A Interpretation and management of hemodynamic N/A data Cannulation and Institution of ECMO N/A Management of extracorporeal membrane N/A oxygenation/life support (ECMO/ECLS) Transthoracic echocardiography (limited) N/A Cricothyrotomy N/A Percutaneous tracheostomy N/A Bronchoscopy N/A Thoracostomy tube insertion/ management N/A UPMC | University of Pittsburgh Medical Center For Reference Only MEDICINE 2013 Page 3 of 5 Privilege MERCYSSSC Intercostal nerve block N/A Abdominal paracentesis N/A Diagnostic ultrasonography N/A *Fluoroscopy N/A Administration of intermittent and continuous N/A sedation, analgesia, and intravenous anesthetics for management of critically ill patients, as well as for moderate and deep sedation Telemedicine DERMATOLOGY Dermatology Disease Management N/A Teledermatology N/A ENDOCRINE / METABOLISM Endocrinology Disease Management X DEXA (Certificate Required) X Thyroid biopsy Tele-endocrinology N/A GASTROENTEROLOGY (GI) GI Disease Management X Anoscopy Procedures X Endoscopy X Esophagoscopy X Colonoscopy X Flexible Sigmoidoscopy X *ERCP N/A Extracorpeal Shock Wave Lithotripsy N/A PEG Tube Placement X Endoscopic Ultrasound N/A Liver Biopsy N/A Paracentesis X Esophageal Sclerotherapy X Small Bowel Capsule Endoscopy (SBCE) X Small Bowel Enteroscopy N/A Motility Studies N/A Esophageal Bougie (except pneumatic dilation) N/A Pneumatic dilation of strictures X GI tract stenting X Halo Ablation N/A Waived testing including pH testing and stool blood N/A testing Fluoroscopy (Certificate Required) X Moderate sedation X Telemedicine HEMATOLOGY/ONCOLOGY Hematology/Oncology Disease Management N/A UPMC | University of Pittsburgh Medical Center For Reference Only MEDICINE 2013 Page 4 of 5 Privilege MERCYSSSC Chemotherapy Bone Marrow Aspiration X Needle Biopsy of Soft Tissue Mass N/A Bone Marrow Biopsy X Bone Marrow Transplantation N/A Fluoroscopy (Certificate Required) N/A Telemedicine HOSPITALIST/GENERAL INTERNAL MEDICINE General Internal Medicine Disease Management N/A Arterial line placement N/A Arthrocentesis N/A CVP line placement N/A Endotracheal Intubation N/A Lumbar puncture N/A Paracentesis N/A PICC line placement N/A Skin biopsy N/A Thoracentesis N/A Tracheostomy N/A Moderate sedation X Telemedicine INFECTIOUS DISEASE Infectious Disease Management X Telemedicine NEUROLOGY Neurological Disorders and Disease Management N/A Telemedicine N/A Botox injections EEG Interpretation N/A EMG/NCV with Interpretation N/A Sleep Study N/A Fluoroscopy (Certificate Required) N/A PULMONARY Pulmonary Disease Management N/A Bronchoscopy X Bronchoscopy with fluoroscopy Navigational bronchoscopy Bronchoscopy with wang needle, Bx Lung Biopsy X *Transbronchial Biopsy N/A Pleural Biopsy X PFT Interpretation N/A Ventilator Management N/A Thoracentesis X Sleep Study N/A Endotracheal Intubation N/A Endobronchial Ultrasound X UPMC | University of Pittsburgh Medical Center For Reference Only MEDICINE 2013 Page 5 of 5 Privilege MERCYSSSC Whole Lung Lavage (performed in OR with general X anesthesia and intubation) Under Sedation-Pleurodesis N/A Moderate sedation N/A Fluoroscopy (Certificate Required) N/A Telemedicine NEPHROLOGY Renal Disease Management N/A Renal Biopsy X Temp Dialysis Catheter Placement N/A Aquaphoresis N/A Therapeutic Apheresis X Administration of Cytotoxic Agents X Fluoroscopy (Certificate Required) N/A Renal Replacement Therapy Hemodialysis X Peritoneal Dialysis X Continuous Veno-Veno N/A Hemofiltration Continuous Veno-Veno N/A Hemofiltration with Hemodialysis Telemedicine RHEUMATOLOGY Rheumatology Disease Management N/A Joint/Soft Tissue Injections X Telemedicine PSYCHIATRY Psychiatric Disease Management N/A Buprenorphine N/A Telemedicine PART B - INTERVENTIONAL VASCULAR PROCEDURES Privilege MERCYSSSC Peripheral Diagnostic Angiography N/A Peripheral Interventions N/A Aortoiliac & Brachiocephalic Vessels N/A Renal & Abdominal Visceral Vessels N/A Infra-inguinal Vessels N/A Intracerebral Interventions N/A Carotid Arteriography N/A Carotid Interventions N/A Revised: 1/8/14 .